Case A26001491

J.P. NORMAN · 2026 · Case ID: A26001491

MIXED

Summary

The veteran, who served in the United States Army from July 1970 to January 1972, including service in the Republic of Vietnam, appeals the denial of an earlier effective date for hypertension and the grant of service connection for COPD and obstructive sleep apnea (OSA). The Board denied the claim for an earlier effective date for hypertension, finding that the August 10, 2022, effective date assigned by the VA, based on the PACT Act, was the earliest possible date given the claim history. The Board noted that hypertension is not a presumptive condition under the Nehmer line of cases related to herbicide exposure, and the veteran's claim for an earlier date was filed within one year of the PACT Act's enactment, which added hypertension to the list of presumptive conditions. The Board found the evidence persuasive against an earlier effective date. For COPD, the Board granted service connection, finding the private medical opinion of Dr. S.B. more probative than the VA examiner's opinion. Dr. S.B. linked the veteran's COPD to conceded herbicide exposure, despite the veteran's smoking history and the VA examiner's inability to find supporting literature. The Board granted a 10 percent rating for hypertension, finding the evidence in approximate balance and resolving doubt in the veteran's favor, based on a history of systolic blood pressure predominantly 160 or more and continuous medication use. For OSA, the Board granted service connection as secondary to PTSD, relying on Dr. S.B.'s opinion that PTSD symptoms and associated obesity contributed to the OSA, outweighing the VA examiner's opinion that OSA was not related to herbicide exposure.

Rationale

No basis to assign earlier effective date; Claim filed within one year of PACT Act liberalizing provisions; August 10, 2022 is earliest possible effective date

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250916-586960

Full Decision Text

Citation Nr: A26001491
Decision Date: 01/07/26 Archive Date: 01/07/26

DOCKET NO. 250916-586960
DATE: January 7, 2026

ORDER

Entitlement to a service connection effective date prior to August 10, 2022 for hypertension is denied.

Entitlement to a 10 percent rating for hypertension from August 10, 2022 is granted.

Entitlement to service connection for chronic obstructive pulmonary disease (COPD) is granted.

Entitlement to service connection for obstructive sleep apnea (OSA), including as due to service-connected disabilities, is granted.

FINDINGS OF FACT

1. The Veteran was awarded presumptive service connection for hypertension as of August 10, 2022, the effective date of the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxins Act of 2022 (PACT Act), which is earlier than the June 2023 date of his service connection claim.

2. The Veteran's hypertension manifests with systolic blood pressure readings that are predominantly 160 or higher for the entire period on appeal.

3. Resolving reasonable doubt in the Veteran's favor, it is at least as likely as not that his COPD is due to herbicide exposure during service.

4. The Veteran's OSA is due to his service-connected PTSD.

CONCLUSIONS OF LAW

1. The criteria for assignment of a service connection effective date earlier than August 10, 2022 for hypertension have not been met. 38 U.S.C. §§ 5101, 5107, 5110; 38 C.F.R. §§ 3.114, 3.155(a), 3.400.

2. The criteria for entitlement to a 10 percent disability rating for hypertension from August 10, 2022 have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.7, 4.104, Diagnostic Code 7101.

3. The criteria for entitlement to service connection for COPD have been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

4. The criteria for service connection for OSA as secondary to PTSD have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from July 1970 to January 1972, including service in the Republic of Vietnam.

In the September 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket. Therefore, the Board may only consider the evidence of record at the time of the February 2024 agency of original jurisdiction (AOJ) decision, which was subsequently subject to higher-level review, as well as any evidence submitted by the Veteran or his representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decision, which was subsequently subject to higher-level review and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801.

The Board is aware that in Williams v. McDonough, 37 Vet. App. 305 (2024), the United States Court of Appeals for Veterans Claims (CAVC) held that the Board may not decide a case until the time has elapsed for the Veteran to switch review lanes on the Board's docket. However, the CAVC did not address the competing principles of: (1) the delay caused by waiting for this "docket switch" time to elapse, versus (2) the VA's commitment to speedily resolving Veterans' appeals, especially those Veterans with emergent life situations as represented by their cases being advanced on the Board's docket. In this case, the Board has no indication that the Veteran wants to switch to any other review lane from the one he has already affirmatively chosen on his VA Form 10182, Decision Review Request: Board Appeal
Claims (CAVC) held that the Board may not decide a case until the time has elapsed for the Veteran to switch review lanes on the Board's docket. However, the CAVC did not address the competing principles of: (1) the delay caused by waiting for this "docket switch" time to elapse, versus (2) the VA's commitment to speedily resolving Veterans' appeals, especially those Veterans with emergent life situations as represented by their cases being advanced on the Board's docket. In this case, the Board has no indication that the Veteran wants to switch to any other review lane from the one he has already affirmatively chosen on his VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement). Further, in the present appeal, the Veteran's case has been advanced on the docket due to the Veteran's age. Thus-given his advanced age-the Board will now give the Veteran a decision as quickly as possible, without further delay. In sum, the Board will issue a decision now, so that this Veteran of advanced age is not prejudiced by any further delay in the adjudication of his claims.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

1. Entitlement to a service connection effective date prior to August 10, 2022 for hypertension is denied.

The Veteran maintains that service connection for his hypertension disability should have been awarded earlier than August 10, 2022, as currently assigned. See February 2024 rating decision.

In general, the effective date of an award based on an initial, supplemental, pension, dependency, and indemnity compensation claim shall be fixed in accordance with the facts found, but shall not be earlier than the date VA received the claim. 38 U.S.C. § 5110. The effective date of an award for service connection is the date of receipt of the claim or date entitlement arose, whichever is later, if the claim if filed outside one year after separation for service. 38 C.F.R. § 3.400(b)(2).

An effective date may be pursued by continuously pursuing a claim. This is accomplished by filing an appropriate administrative review option to an AOJ decision as specified in 38 C.F.R. § 3.2500(c) within one year of the issuance of the decision (or within the time specified in § 3.2500(f), as applicable to simultaneously contested claims), provided that any appeal to the CAVC must be accepted as timely by that court. 38 C.F.R. § 3.2500(h)(1). If a claim is continuously pursued it will be considered filed as of the date of the first claim in the continuously pursued chain, not the date the most recent request for review was received. 38 C.F.R. §§ 3.400, 3.2500(c).

A claimant may also preserve an earlier date of claim by submitting written intent to file (ITF), which establishes a claim date that applies to the next complete application filed within 1 year of filing the ITF. 38 C.F.R. § 3.155(b). The regulations further indicate that an ITF "followed by a complete claim" will close out that ITF and the Veteran may then file a new ITF. 38 C.F.R. § 3.155(b)(6). The language of the regulations indicates an ITF preserves the effective date for a complete application filed within one year thereafter.

The VA has promulgated special rules for the effective dates for the award of presumptive service connection based on exposure to herbicides, pursuant to orders of a United States District Court in the class action of Nehmer v. United States Department of Veterans Affairs. See 38 C.F.R. § 3.816; see also Nehmer v. United States Veterans Administration, 712 F. Supp. 1404 (N.D. Cal. 1989) (Nehmer I); Nehmer v. United States Veterans Administration, 32 F. Supp. 2d. 1175 (N.D. Cal. 1999) (Nehmer II); Nehmer v. Veterans Administration of the Government of the United States, 284 F.3d 1158 (9th Cir
connection based on exposure to herbicides, pursuant to orders of a United States District Court in the class action of Nehmer v. United States Department of Veterans Affairs. See 38 C.F.R. § 3.816; see also Nehmer v. United States Veterans Administration, 712 F. Supp. 1404 (N.D. Cal. 1989) (Nehmer I); Nehmer v. United States Veterans Administration, 32 F. Supp. 2d. 1175 (N.D. Cal. 1999) (Nehmer II); Nehmer v. Veterans Administration of the Government of the United States, 284 F.3d 1158 (9th Cir. 2002) (Nehmer III). Critically, these cases only address service connection for a "covered herbicide disease," defined as a disease for which the Secretary of Veterans Affairs has established a presumption of service connection before October 1, 2002, pursuant to the Agent Orange Act of 1991. 38 C.F.R. § 3.816. Hypertension is not among these identified diseases and as such, Nehmer and its progeny do not apply.

In August 2022, the President of the United States signed into law the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 (PACT Act), which became effective on August 10, 2022. See Pub. L. 117-168. Among other things, the PACT Act added hypertension as one of the diseases presumptively linked with herbicide exposure. VA regulations provide that where a service connection claim is received by VA within one year after a change in law, such as the PACT Act, and all the requirements were met for a grant of service connection on the effective date of the change in law, the proper effective date shall be the date of the change in the law. 38 C.F.R. § 3.114(a).

The Veteran was awarded service connection for hypertension as due to Agent Orange exposure during service in the Republic of Vietnam. See November 2023 VA memorandum; February 2024 rating decision. The record reflects that he filed a June 23, 2023 ITF, followed two months later by his first service connection claim for hypertension on record. See August 2023 VA 21-526EZ claim. There is no indication of an earlier hypertension, high blood pressure, or associated claim.

The earliest date of claim is accordingly June 23, 2023, within a year of the PACT Act's liberalizing provisions that added hypertension to the list of disabilities associated with Agent Orange exposure. The VA accordingly awarded service connection effective August 10, 2022, the effective date of the PACT Act, consistent with the provisions of 38 C.F.R. § 3.114(a). There are no other claims related to hypertension pre-dating August 10, 2022.

The Board simply and regrettably cannot escape the conclusion that there is no basis to assign any earlier effective date for service connection prior to that already in effect. 38 U.S.C. § 5110(b)(2); 38 C.F.R. § 3.400(o)(1)(2); Harper v. Brown, 10 Vet. App. 125, 126 (1997); VAOPGCPREC 12-98 (Sept. 23, 1998). The law and regulations surrounding the assignment of an effective date for an initial claim for service connection benefits are clear and specific. 38 C.F.R. § 3.400. When the claim is received more than one year after active duty discharge, the effective date is the later choice between when entitlement arose and date of receipt, and there are additional exceptions applicable when an ITF may serve as the date for service connection or when a liberalizing law has been enacted. Both exist in this case and, here, the earliest possible effective date has already been assigned.

Accordingly, the persuasive weight of the evidence is against the claim for an effective date prior to August 10, 2022, for the award of service connection for hypertension and, as such, the benefit-of-the-doubt doctrine does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). The claim must be hereby DENIED.

2. Entitlement to a 10
already been assigned.

2. Entitlement to a 10 percent rating for hypertension from August 10, 2022 is granted.

The Veteran additionally asserts that his hypertension manifests with symptoms warranting a compensable rating. He was awarded service connection for this disability in the February 2024 rating decision on appeal, which has been timely appealed since. The severity of his disability will be considered from August 10, 2022, the date of service connection for this disability. Fenderson v. West, 12 Vet. App. 119 (1999).

Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule) and are intended to represent the average impairment of earning capacity resulting from disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Disabilities must be reviewed in relation to their history. 38 C.F.R. § 4.1. A claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Thus, separate ratings can be assigned for separate periods of time based on the facts found, a practice known as "staged" ratings. Fenderson, 12 Vet. App. 119; Hart v. Mansfield, 21 Vet. App. 505 (2007).

Hypertension is rated pursuant to 38 C.F.R. § 4.104, Diagnostic Code (DC) 7101, for hypertensive vascular disease (hypertension and isolated systolic hypertension). Under DC 7101, a 10 percent rating requires diastolic (bottom number on the reading) blood pressure predominantly 100 or more, or systolic (top number on the reading) blood pressure predominantly 160 or more, or minimum evaluation for an individual with a history of diastolic blood pressure predominantly 100 or more which requires continuous medication for control. 38 C.F.R. § 4.104, DC 7101. A rating of 20 percent requires diastolic blood pressure predominantly 110 or more or systolic blood pressure predominantly 200 or more. A rating of 40 percent requires diastolic blood pressure predominantly 120 or more. A maximum disability rating of 60 percent for hypertension requires diastolic blood pressure predominantly 130 or more.

The term "predominant" is not defined in the rating criteria. Predominant is defined as "being most frequent or common." See, e.g., "predominant," Merriam-Webster.com Online Dictionary, https://www.merriam-webster.com/dictionary/predominant.

The medical record reflects a history of blood pressure readings with a systolic number often greater than 160, but less than 200. See, e.g., April 2018 (186/88), October 2018 (192/95, 185/87), January 2019 (190/91), June 2019 (180/99, 176/92), February 2020 (191/87, 186/87). Medical records throughout the period on appeal indicate the Veteran was prescribed several medications for blood pressure control. His October 2023 VA examination established he was on continuous medication for hypertension at that time. Blood pressure readings cited in that examination, taken between September 2022 and September 2023, were 149/90 and 130/80.

Considering the Veteran's medical history and acknowledging that the long-term use of continuous medication for symptom control likely had ameliorative effects on his blood pressure readings, the Board finds a history of systolic blood pressure predominantly 160 or more. In making this finding, the Board is cognizant that DC 7101 contemplates the ameliorative effects of medication, but only in the specific context of rating hypertension based on a diastolic reading of 100 or more. That reading, and analysis, is not warranted in this case. In sum, the systolic readings
readings cited in that examination, taken between September 2022 and September 2023, were 149/90 and 130/80.

Considering the Veteran's medical history and acknowledging that the long-term use of continuous medication for symptom control likely had ameliorative effects on his blood pressure readings, the Board finds a history of systolic blood pressure predominantly 160 or more. In making this finding, the Board is cognizant that DC 7101 contemplates the ameliorative effects of medication, but only in the specific context of rating hypertension based on a diastolic reading of 100 or more. That reading, and analysis, is not warranted in this case. In sum, the systolic readings of record warrant a 10 percent rating, but no higher, under applicable rating criteria. 38 C.F.R. § 4.104, DC 7101.

The Board does not find evidence that this disability manifests with symptoms unaccounted for by application of the schedular rating criteria, such that application of the schedular rating criteria would be rendered impractical. Thun v. Peake, 22 Vet. App. 111, 115 (2008), aff'd, Thun v. Shinseki, 572 F.3d 1366 (Fed. Cir. 2009); 38 C.F.R. §§ 4.1, 4.10. Further, the record does not indicate that his hypertension symptoms manifest with functional impairment. As such, the Board does not find any claim related to employability arose in relation to this claim. See Rice v. Shinseki, 22 Vet. App. 447, 453 (2009); Buie v. Shinseki, 24 Vet. App. 242 (2010).

The evidence is at least in approximate balance as to whether the criteria for a compensable rating for a hypertension disability are met from the date of service connection. Therefore, a 10 percent rating, but no higher, is GRANTED from August 10, 2022. Lynch, 21 F.4th 776; Ortiz, 274 F.3d 1361.

3. Entitlement to service connection for chronic obstructive pulmonary disease (COPD) is granted.

The Veteran further asserts that he has COPD as a result of his military service.

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. Generally, service connection requires (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004).

If a veteran was exposed to an herbicide agent during active military, naval, or air service, certain enumerated diseases shall be service connected even though there is no record of such disease during service. 38 C.F.R. § 3.309(e). The diseases listed in 38 C.F.R. § 3.309(e), shall have become manifest to a degree of 10 percent or more at any time after service. 38 C.F.R. § 3.307 (a)(6)(ii).

If a veteran was exposed to an herbicide agent during active military, naval, or air service, the following diseases shall be service-connected if the requirements of 38 C.F.R. § 3.307 (a)(6)(iii) are met, even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 C.F.R. § 3.307 (d) are also satisfied: AL amyloidosis, chloracne or other acneform diseases consistent with chloracne, diabetes mellitus (Type II), Hodgkin's disease, ischemic heart disease (including, but not limited to, acute, subacute, and old myocardial infarction; atherosclerotic cardiovascular disease including coronary artery disease (including coronary spasm) and coronary bypass surgery; and stable, unstable and Prinzmetal's angina), hairy cell leukemia and other chronic B-cell leukemias, multiple myeloma, non-Hodgkin's lymphoma, Parkinson's disease, early-onset peripheral neuropathy, porphyria cutanea tarda, prostate cancer, respiratory cancers (cancer of the lung, bronchus, larynx, or trachea), and soft-tissue sarcom
ne, diabetes mellitus (Type II), Hodgkin's disease, ischemic heart disease (including, but not limited to, acute, subacute, and old myocardial infarction; atherosclerotic cardiovascular disease including coronary artery disease (including coronary spasm) and coronary bypass surgery; and stable, unstable and Prinzmetal's angina), hairy cell leukemia and other chronic B-cell leukemias, multiple myeloma, non-Hodgkin's lymphoma, Parkinson's disease, early-onset peripheral neuropathy, porphyria cutanea tarda, prostate cancer, respiratory cancers (cancer of the lung, bronchus, larynx, or trachea), and soft-tissue sarcomas (other than osteosarcoma, chondrosarcoma, Kaposi's sarcoma, or mesothelioma). 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307 (a)(6)(iii), 3.309(e).

As a preliminary matter, presumptive service connection for herbicide exposure does not include COPD, and as such, service connection is not warranted on a presumptive basis. 38 C.F.R. §§ 3.307, 3.309. However, the Veteran is not precluded from establishing service connection with proof of direct causation. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994).

The AOJ has favorably found that the Veteran has a current COPD diagnosis and was exposed to herbicides, including Agent Orange, during his service in the Republic of Vietnam. See February 2025, May 2025 rating decisions.

A December 2023 VA medical opinion stated that a close review of the medical record did not show any risk factors for COPD, although the examiner later indicated that the Veteran had a prolonged history of smoking. It also concluded that service treatment records (STRs) likewise did not show complaints, symptoms, or diagnosis of COPD during service. The examiner could not find any medical literature associating COPD with herbicide exposure. Given the length of time between separation from service and the diagnosis of COPD in July 2023, along with the Veteran's smoking history, the examiner concluded that it was less likely than not that his COPD was related to service and more likely that it was related to smoking.

In September 2025 and within the acceptable period to file new evidence, the Veteran submitted a medical opinion from Dr. S.B., who specializes in internal medicine, neurology, and pharmacology. Dr. S.B. was provided with and reviewed the entire claims file, including the VA medical opinion discussed above. His opinion indicates that he was aware of and considered the Veteran's history of smoking. Regardless, he provided a detailed analysis related to the physical effects of dioxin and other compounds found in Agent Orange, citing VA and other medical literature, in finding it at least as likely as not that the claimed COPD is the direct result of conceded herbicide exposure in service.

This case accordingly presents conflicting medical opinions that the Board must evaluate to determine their relative probative value. AZ v. Shinseki, 731 F.3d 1303, 1311 (Fed. Cir. 2013). The probative value of a medical opinion is based on the medical expert's personal examination of the patient, the physician's knowledge and skill in analyzing the data, and the medical conclusion the physician reaches. Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). Whether a clinician provides a basis for a medical opinion goes to the weight or credibility of the evidence in the adjudication of the merits. Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998). Further, a veteran is entitled to the benefit of the doubt when the evidence of record is in an approximate balance, rather than in "exact" equipoise, so that a claimant's application may be denied only when the evidence "persuasively favors" a finding against the claim. Lynch, 999 F.3d 1391; see also Alemany v. Brown, 9 Vet. App. 518, 519 (1996).

Both opinions were provided by medical professionals who had access to and examined the entire claims file, offering cogent opinions citing the Veteran's specific medical history. Neither opinion is inadequate for rating purposes. However, the Board finds that Dr. S.B.'s opinion identified and considered both the specific chemicals involved in herbicide exposure and the specific effects of those chemicals on the body, within the context of this claim.
equipoise, so that a claimant's application may be denied only when the evidence "persuasively favors" a finding against the claim. Lynch, 999 F.3d 1391; see also Alemany v. Brown, 9 Vet. App. 518, 519 (1996).

Both opinions were provided by medical professionals who had access to and examined the entire claims file, offering cogent opinions citing the Veteran's specific medical history. Neither opinion is inadequate for rating purposes. However, the Board finds that Dr. S.B.'s opinion identified and considered both the specific chemicals involved in herbicide exposure and the specific effects of those chemicals on the body, within the context of this claim. The VA examiner's opinion was more generalized, stating broadly that the examiner could not identify medical research supporting the Veteran's claim. The Board accordingly finds Dr. S.B.'s thorough, thoroughly supported medical opinion of relatively greater probative value. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).

The record accordingly reflects a current COPD diagnosis, conceded exposure to the herbicide Agent Orange during service, and a positive, probative medical nexus opinion. The only contrary evidence is of lesser probative value and as such, the Board places greater weight on the positive opinion. The evidence is therefore at least in approximate balance regarding whether the Veteran's COPD is due to herbicide exposure in the Republic of Vietnam and as such, service connection for this disability is GRANTED. Lynch, supra; Ortiz, 274 F.3d 1361.

4. Entitlement to service connection for obstructive sleep apnea (OSA), including as due to service-connected disabilities, is granted.

Finally, the Veteran asserts that he has OSA due to his service-connected posttraumatic stress disorder (PTSD). See September 2025 Veteran's brief.

The principles for awarding service connection expressed above also apply to this claim. Additionally, establishing service connection on a secondary basis requires sufficient evidence to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. See 38 C.F.R. § 3.310; but see Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023) (holding all that is needed is a "but for" causation or aggravation to show entitlement to secondary service connection).

Here again, the AOJ has favorably found a current OSA diagnosis, herbicide exposure during active duty, and an established award of service connection for PTSD. See February 2025, May 2025 rating decisions.

As above, the AOJ obtained a December 2023 VA medical opinion regarding the etiology of this claimed condition. The VA examiner cited the medical record and research in concluding that OSA is not related to herbicide exposure. There are no conflicting medical opinions of record.

The September 2025 medical opinion prepared by Dr. S.B. found it at least as likely as not that the Veteran's OSA is at least aggravated by, if not directly due to, PTSD. Dr. S.B. described the effect of PTSD symptoms, including stress and hyperarousal, on contributing to OSA. Notably, the VA compensates the Veteran for service-connected PTSD with symptoms including sleep impairment and panic attacks. See June 2025 rating decision. Dr. S.B. additionally noted that PTSD, and particularly depression compensated under the Veteran's PTSD, contributes to the development of obesity, which is a risk factor for OSA. Considering both the direct effects of PTSD on the Veteran's sleep and the indirect development of obesity, Dr. S.B. concluded that his OSA developed as a result of service-connected PTSD. This opinion is also unrefuted on record.

In sum, the record reflects a VA medical opinion that disassociates the claimed condition from herbicide exposure, and a private medical opinion that associates it with service-connected disabilities. The evidence is therefore at least in approximate balance regarding whether the Veteran's OSA is due to PTSD and as such, service connection for this disability is GRANTED. Lynch, supra; Ortiz, 274 F.3d 1361.

(This space intentionally left blank. VLJ signature on next page.)

J.P. Norman

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board W. Stearns, Counsel

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F
private medical opinion that associates it with service-connected disabilities. The evidence is therefore at least in approximate balance regarding whether the Veteran's OSA is due to PTSD and as such, service connection for this disability is GRANTED. Lynch, supra; Ortiz, 274 F.3d 1361.

(This space intentionally left blank. VLJ signature on next page.)

J.P. Norman

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board W. Stearns, Counsel

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